Provider Demographics
NPI:1619368255
Name:REAVES, SHINERIKA (LPC)
Entity type:Individual
Prefix:
First Name:SHINERIKA
Middle Name:
Last Name:REAVES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 EMERY HWY
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-3692
Mailing Address - Country:US
Mailing Address - Phone:478-803-7626
Mailing Address - Fax:478-803-8596
Practice Address - Street 1:175 EMERY HWY
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-3692
Practice Address - Country:US
Practice Address - Phone:478-803-7626
Practice Address - Fax:478-803-8596
Is Sole Proprietor?:No
Enumeration Date:2015-02-17
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008872101YM0800X
GAAPC004715101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAAPC004715OtherLICENSED ASSOCIATE PROFESSIONAL COUNSELOR
GALPC008872OtherLPC